| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NONE | — | DELTA DENTAL OF CALIFORNIA | — | — | $0 | 0.00% |
| NONE | — | STANDARD INSURANCE COMPANY | — | — | $0 | 0.00% |
| NONE | — | STANDARD INSURANCE COMPANY | — | — | $0 | 0.00% |
| NONE | — | STANDARD INSURANCE COMPANY | — | — | $0 | 0.00% |
| CYNTHIA L. MOHON4 Filed as: CYNTHIA L MOHON | 15 N MICHIGAN ST REDLANDS, CA 92373 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $226 | — | $226 | 4.42% |
| DEBRA OTTEN4 Filed as: DEBRA L OTTEN | 123 BRISTOL LN MAPLES, FL 34112 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $145 | — | $145 | 2.83% |
| PATRICIA SWANSON4 | 579 W LEMON AVE MONROVIA, CA 91016 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $38 | — | $38 | 0.74% |
| PAM MROZ4 | 6770 BRADFORD CT CHINO, CA 91710 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $37 | — | $37 | 0.72% |
| NANCY O. LEWIS4 Filed as: NANCY O LEWIS | 2387 GRACE ST RIVERSIDE, CA 92504 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $28 | — | $28 | 0.55% |
| NONE | — | TRANSAMERICA LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| NONE | — | STANDARD INSURANCE COMPANY | — | — | $0 | — |
| NONE | — | DELTA DENTAL OF CALIFORNIA | — | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OCEA EIN 33-0660405 ADMINISTRATOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $1.0M |
| DELTA DENTAL EIN 94-1461312 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $382K |
| VISION SERVICE PLAN EIN 94-1632821 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $162K |
| DIMARTINO ASSOCIATES EIN 91-0378940 NONE | Direct payment from the plan Service code 50 | — | $111K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $20K |
| HIGHLAND CAPITAL ADVISORS LLC EIN 20-4284376 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $15K |
| THE WAGNER LAW GROUP EIN 04-3323315 NONE | Legal; Direct payment from the plan Service code 29 | — | $9K |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 11,064 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2,574 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 13,638 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 13,384 | $2.2M |
| Life insurance(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 23,488 | $1.8M |
| Short-term disability | STANDARD INSURANCE COMPANY | 12,089 | $833K |
| Long-term disability(2 contracts) | STANDARD INSURANCE COMPANY | 13,048 | $2.1M |
| Other | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | 22 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 23,488 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.